Efficacy and safety of electroacupuncture for post-stroke depression: a systematic review and meta-analysis

Background Depression is a common comorbid condition in stroke patients, significantly impairing their quality of life. Electroacupuncture (EA) has shown promising effects in treating post-stroke depression (PSD), but integrated evidence remains scarce. Objective To investigate the efficacy of EA in improving PSD and evaluate its clinical effectiveness and safety through systematic review and meta-analysis. Methods We searched eight electronic databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP Data Platform, Wanfang Data Knowledge Service Platform, and China Biomedical Literature Service System) and manually reviewed reference lists of relevant literature and clinical trial registries for randomized controlled trials (RCTs) of EA for PSD. Eligible studies were screened based on inclusion and exclusion criteria, and relevant data were extracted. Meta-analysis was performed using RevMan 5.4 software. Results A total of 22 studies involving 1,640 patients were included. Meta-analysis results showed that EA improved HAMD (MD = −1.71, 95% CI: −2.79 to −0.63, I 2 = 89%, p = 0.002), efficacy rate (OR = 1.94, 95% CI: 1.43 to 2.64, I 2 = 0%, p < 0.0001), and safety (OR = 0.2, 95% CI: 0.12–0.34, I 2 = 45%, p < 0.00001). However, it did not show superiority over the control group in terms of the Barthel Index (BI) (MD = 4.01, 95% CI: −0.26 to 8.27, I 2 = 70%, p = 0.07) and SDS (MD = −3.28, 95%CI: −6.78 to 0.21, I 2 = 97%, p = 0.07). The GRADE assessment indicates that the evidence level for HAMD is very low, while that for BI is low. Conclusion EA demonstrated superiority over conventional drug therapy in improving HAMD scores, efficacy rates, and safety. However, no significant difference was observed between EA and the control group in improving BI and SDS scores. The pooled results for HAMD scores and SDS showed high heterogeneity, and the study itself exhibited considerable heterogeneity. Furthermore, all included studies were conducted in China, which may introduce regional bias. Future rigorous clinical research is needed to provide high-quality evidence.